Nightmares in the cathlab My worst case and how I...Nightmares in the cathlab – My worst case and...
Transcript of Nightmares in the cathlab My worst case and how I...Nightmares in the cathlab – My worst case and...
![Page 1: Nightmares in the cathlab My worst case and how I...Nightmares in the cathlab – My worst case and how I solved it Koen Deloose, MD Head Vascular Surgery Sint Blasius Hospital Dendermonde,](https://reader036.fdocuments.us/reader036/viewer/2022070217/612190b51f43e657ef6d89c1/html5/thumbnails/1.jpg)
Nightmares in the cathlab –My worst case and how I
solved itKoen Deloose, MD
Head Vascular Surgery
Sint Blasius Hospital
Dendermonde, Belgium
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2iD3 Medical – 2018 |
Disclosure slide
I have the following potential conflicts of interest to report:
Consulting: Medtronic, Spectranetics, Biotronik, Abbott, Bard
iVascular, Bentley, Cook, GE Healthcare, Cardionovum, Contego
Medical, B Braun.
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
Speaker name: Koen Deloose, MD
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Nightmares in the cathlab –My worst case and how I
solved itKoen Deloose, MD
Head Vascular Surgery
Sint Blasius Hospital
Dendermonde, Belgium
did I solve it ???
NO
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4iD3 Medical – 2018 |
Clinical Data, male patient 76yrMedical History:
1999 : PTA/stenting left PA ; 2005 : reversed venous P1-ATP-bypass ; 2016 : PTA/stenting left SFA
Risk factors:smoker, hypercholesterolemia
Recent diagnosis pulmonary cancer, with chemotherapy
Present state:
Subacute left leg rest pain since 10 days (RutherfordBecker 4) without motoric or sensory loss
Duplex Ultrasound : normal triphasic signal both CFA –
Occlusion of the left SFA – bypass – reinjection ATP
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5iD3 Medical – 2018 |
Preoperative angiography
• Right CFA access 4F• Cross over procedure
UF (Cordis) + 0.035”-260cm stiff, straight glidewire (Terumo)
Very smoothpassage
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6iD3 Medical – 2018 |
Decision to 24H thrombolysis
Fixation thrombolysis Unifuse catheter 4F-90cm-20cm sideholes (Angiodynamics) – Urokinase (1500U/kg/h)
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7iD3 Medical – 2018 |
Result 24hours post thrombolysis• Right CFA access 6F• Destination sheath 6F-45cm
(Terumo)
• Straight0.035”-260cm GW(Terumo)
• CXI 4F-150cm (Cook)
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8iD3 Medical – 2018 |
Result post Rotarex thrombectomy
• 0.018”-300cm Advantage GW (Terumo)
• 6F Rotarex (Straub Medical)
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9iD3 Medical – 2018 |
Result post Rotarex thrombectomy
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10iD3 Medical – 2018 |
Result post Rotarex thrombectomy
MECHANICAL DISRUPTION
Tercross balloon OTW (Terumo) ; 3.0-200mm ; 148cm ; 4F
Metacross balloon OTW (Terumo) ; 5-150mm ; 135cm ; 5F
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11iD3 Medical – 2018 |
Eliminate Thrombus aspiration
Eliminate thrombusaspirationcatheter (Terumo) (6-7F)
The stiffening stylet and fully braided shaft construction provides improved pushability and Kink resistance and
ensures optimal crossability
The large extraction lumen and rounded, short tip design provides optimal aspiration
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12iD3 Medical – 2018 |
Result post Eliminate aspiration
Slow flow to the ankle…
Trash foot???
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13iD3 Medical – 2018 |
Loosing my patience…
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14iD3 Medical – 2018 |
Final result after thrombectomy
• Acceptable flow through SFA, popliteal bypass and ATP
• Heparine 25000U/24h + ASA + Clopidogrel
• Difficult recovery post surgery• Immediate capillary refill – no
ATP pulse – powerfull biphasicsignal on doppler
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15iD3 Medical – 2018 |
Safe and efficient closure…!
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16iD3 Medical – 2018 |
…the day after….
During the night… a lot of pain in left foot
Deterioration of temperature after 8 hours
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17iD3 Medical – 2018 |
Take home messages
• You need a wide armamentarium of thrombusfighters : thrombolysis, thrombectomy devices, thrombusaspiration (like Eliminate), balloons (like Tercross & Metacross), stents, surgical skills
• Caveat oncological patients : paraneoplastic& thrombophilic phenomenons
• Despite all technological evolutions, high techdevices, increased skills…there are still limits on ourpossibilities…
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Nightmares in the cathlab –My worst case and how I
solved itKoen Deloose, MD
Head Vascular Surgery
Sint Blasius Hospital
Dendermonde, Belgium